Long ride to the hospital: Ambulance services adjust to changing medical landscape in Berkshire County

North Adams Ambulance paramedics Dean Stockley, left, and Kevin O'Mara are seen in the ambulance bay as they prep their vehicle and wait for a call. Tuesday, July 5, 2016.

Village Ambulance Executive Director Michael Witkowski stands in the ambulance bay with one of the more tradition ambulance vehicles. The fleet also contains a van style ambulance which is smaller and costs significantly less. The ambulance service, a non-profit organization, depends a large part on donations from citizens to run their operation for the community. Wednesday, July 6, 2016.

North Adams Ambulance, seen here on July 5, is packed to capacity since they put more ambulances into service to accomodate the travel to the two nearest hospitals in Bennington and Pittsfield, since the closure of North Adams Regional Hospital in 2014.

This much smaller van ambulance is one in Village Ambulance's fleet. It carries the same equipment in a much smaller space. They are also significantly less expensive. Wednesday, July 6, 2016.

The on-call room which has a single bed for a paramedic doing an overnight shift, is also a storage closet.

North Adams Ambulance has been located on River Street since 1993 and is packed to capacity. The special operations unit, which used to be housed in the ambulance building, now has to be outside to accomodate the addition ambulances put into service since the closure of North Adams Regional Hospital in 2014.

NORTH ADAMS — Prior to the unexpected closure of North Adams Regional Hospital in 2014, the North Adams Ambulance Service employed between 30 and 35 people.

Today, it employs almost 60.

The sharp increase in staffing is just one of a number of adjustments North Adams Ambulance and other ambulance companies in the Northern Berkshires have had to make in the absence of inpatient care in North Adams.

The new health care landscape in Berkshire County has resulted in longer ambulance rides, a shortened vehicle lifespan, and other headaches for ambulance administrators. But leaders of the Northern Berkshires' three ambulance companies say that, more than two years later, they've adapted to the gaps left in the hospital's wake.

In the case of North Adams Ambulance, about 50 percent of its calls — just under 6,000 a year, in total — now head straight to Berkshire Medical Center in Pittsfield. What was once a 15 to 20 minute turnaround time for an emergency ride to the North Adams hospital is now often a two-hour, roughly 44-mile, round trip.

"That was one of our biggest hurdles," said John Meaney Jr., general manager of the North Adams Ambulance Service. "We ended up having to add an additional ambulance and add additional staff to all three of our shifts."

North Adams Ambulance added a fourth crew to its daytime shift, a third crew to its late shift, and an additional crew on its overnight shift, Meaney said.

Transfer times also have grown for Village Ambulance, which serves the residents of Hancock, Williamstown, New Ashford and a part of Pownal, Vt, from a typical turnaround time of 45 minutes to at least one and one half hours.

"It is a resource drain, because now those trucks are out of service," said Village Ambulance Executive Director Michael Witkowski.

"Our call volume has increased, milage per call increased, and time out of service for each has increased," said Michael Gleason, general manager of the nonprofit. "You have to try to compensate and maintain [services]."

If transfers take trucks out of service, ambulance companies can be forced to rely on mutual aid in a pinch.

Witkowski, who was appointed to his position earlier this year, has changed the way ambulance personnel are scheduled to better-align staffing with demand in order to contain costs.

Adams Ambulance has grown from a staff of between 23 and 25 employees to 36 today, Gleason estimates.

The ambulance services worked quickly, in conjunction with Berkshire Medical Center, after the hospital's closure to adapt to the new health care landscape in the county and establish new protocols. But other adjustments happened more slowly.

"We realized one thing we were lacking in was actual staff," Meaney said. "We're working these employees and it was showing."

While a majority of those new employees are part-timers with other full-time jobs, North Adams Ambulance also added more paramedics to enhance coverage and compensate for longer transport times.

Village Ambulance personnel have to make quick decisions about where to bring patients, with Berkshire Medical Center in Pittsfield, Southwestern Vermont Medical Center, and the North Adams Campus of Berkshire Medical Center all viable options, depending on the emergency.

If a patient is believed to require admission, such as in the case of a stroke or cardiac issue, the ambulance will bypass the North Adams campus altogether.

The ambulance companies have also seen increased wear and tear on their vehicles, which are forced to travel farther on a daily basis.

Before the hospital closed, a North Adams ambulance would typically travel about 30,000 miles a year; now it racks up about twice as much distance on the road.

A new ambulance, fully equipped, can cost up to $200,000, Witkowski said, and with the extra milage "the life expectancy is cut down on those." The annual cost of one fully-staffed and equipped ambulance on the road, all hours and days of the year, is about $875,000, he estimates.

As costs for the ambulance services increase, patients' burden varies wildly, depending on their insurance coverage. Witkowski noted that many new insurance plans have large deductibles, and ambulance rides are often not exempt.

So a patient may have been under the impression that his or her ambulance care would be paid in full by insurance, but the cost was actually put toward the patient's deductible — meaning the patient must pay the full bill, which averages close to $900, Witkowski said.

A patient whose insurance doesn't cover the ride often ends up not paying the bill, administrators noted, and there's little they can do to force a person to pay.

The three ambulance companies also lost out on transfer business when the hospital closed. North Adams Ambulance had frequently transferred patients from North Adams Regional Hospital to hospitals such as a Baystate Medical Center in Springfield if they were in need of more in-depth care. But with the hospital gone, North Adams Ambulance rarely is used for transfers out of Pittsfield.

The transfers are a more reliable source of payment for services, according to Witkowski, because the ambulance companies know in advance that either the insurance company or facility is paying for the ride.

Witkowski noted that Village Ambulance, which is about to begin another fundraising drive, has made these adjustments without taxpayer funding.

"We've made changes, we've watched our budget closely and strategically made certain decisions based on that," Meaney said. "We have a community that is very supportive of the ambulance and we've seen [donations] steadily increase since the hospital closed."

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